Relationship Between Cognitive Impairments and Rated Activity Restrictions in Stroke Patients 

Various researchers disagree as to whether functional impairments after stroke are more closely related to cognitive limitations or physical/motor limitations. The authors of this study assessed the relationship between cognitive impairments and activity restrictions after stroke by collecting data that measured both cognitive abilities and psychosocial activities in order to study this question more fully. Data were also gathered from two different sources: ratings made by staff members or relatives as well as ratings made by patients themselves. Previous research has found that these two groups often differ in their assessments of functional capacity. The authors propose that this discrepancy may be due to excessive optimism on the part of patients, cognitive impairments which limit their objectivity or, alternately, may somehow be a product of bias on the part of family or staff raters.

Participants were 87 stroke patients admitted to either of two rehabilitation hospitals in Germany. Participants ranged from 23 to 76 years of age (median age = 52.8 years) and the median time since onset of injury was 73 days. Seventy of the patients were recovering from cerebral infarction; the remaining 17 had sustained intracerebral hemorrhage.

Measurements were taken of post-stroke impairment in three areas: general intelligence, memory and attention. Activity restriction was measured with the Competency Rating Scale (CRS) which assessed level of impairment in various daily activities and real-world situations. The CRS ratings were completed both by patients themselves and by staff or family members. All assessments were completed during the first two weeks of the patients' hospitalization. Subjects also completed a depression scale.

The authors found that cognitive impairments were, overall, the most reliable predictors of activity restrictions, accounting for 5% to 23% of the variance observed in post-stroke functional impairment. General intellectual functioning and capacity for sustained attention were the most reliable predictors. This replicated earlier findings which indicated that intellectual functions were the best prognostic indicators of subsequent activity restrictions.

The authors also found that patients and staff showed only minimal agreement in their ratings of various functional impairments. Patients tended to rate themselves as more competent than did staff members in areas involving motor activities such as driving a car, speaking or walking. In contrast, patients tended to rate themselves as less competent than did staff members in areas related to cognitive skills like memory, or emotional functioning, such as controlling -anger. This pattern has been documented elsewhere and the authors suggest that because motor skills are so well-trained and 'overlearned' patients are less likely to sense or acknowledge impairment in these areas.

Patients who were more severely cognitively impaired or who scored higher on the depression measure, however, tended to rate themselves as more impaired than did staff members in nearly all areas of functioning. The authors conclude, then, that depression and overall cognitive impairment are significant moderating variables to consider when analyzing self assessments made by post-stroke patients. They also caution that subsequent researchers should be mindful of the bias found here in patients' self-reports and strive to gather the most objective data possible when assessing post-stroke functioning.

Article may be found at: 

Relationship Between Cognitive Impairments and Rated Activity Restrictions in Stroke Patients Gauggel, S., Peleska, B., & Bode, R. K. Journal of Head Trauma Rehabilitation, 2000;15(l): 710-723.

Article abstracted by 
Glen E. Heiss, Ph.D., 
Staff Psychologist, 
Jamaica Hospital Department of Physical Medicine and Rehabilitation.